Comparable Outcome of Alternative Donor and Matched Sibling Donor Hematopoietic Stem Cell Transplant for Children with Acute Lymphoblastic Leukemia in First or Second Remission Using Alemtuzumab in a Myeloablative Conditioning Regimen

Alana A. Kennedy-Nasser, Catherine M. Bollard, G. Doug Myers, Kathryn S. Leung, Stephen Gottschalk, Yiqun Zhang, Hao Liu, Helen E. Heslop, Malcolm K. Brenner, Robert A. Krance

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

HLA-matched sibling donor (MSD) stem cell transplantation can cure >60% of pediatric patients with acute lymphoblastic leukemia (ALL), but <30% of patients will have a sibling donor. Alternative donor (AD) transplantation can be curative but has a higher risk of graft-versus-host disease (GVHD). The addition of alemtuzumab (Campath 1-H) to AD transplants produces in vivo T cell depletion, which may reduce the risk for GVHD. We now report the outcome for 83 children with ALL (41 MSD, 42 AD) undergoing stem cell transplantation in first or second complete remission. All patients received myeloablative conditioning, including cyclophosphamide, cytarabine arabinoside, and total-body irradiation, with alemtuzumab administered to AD recipients. GVHD prophylaxis consisted of a calcineurin inhibitor with either short-course methotrexate or prednisone. Disease-free survival (DFS) for MSD recipients was 72.3% (95% confidence interval [CI], 55.4%-83.6%) versus 62.4% (95% CI, 45.2%-75.4%) for AD recipients. The 100-day mortality was 7.1% in the AD group and 2.4% in the MSD group. Relapse rates were identical (24%). Treatment-related mortality, principally viral infection, explained the difference in survival. For children undergoing stem cell transplantation (SCT) from alternative donors, alemtuzumab with a myeloablative conditioning regimen resulted in DFS comparable to MSD.

Original languageEnglish (US)
Pages (from-to)1245-1252
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2008
Externally publishedYes

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Hematopoietic Stem Cells
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Siblings
Tissue Donors
Transplants
Stem Cell Transplantation
Graft vs Host Disease
Conditioning (Psychology)
alemtuzumab
Disease-Free Survival
Confidence Intervals
Mortality
Whole-Body Irradiation
Cytarabine
Virus Diseases
Prednisone
Methotrexate
Cyclophosphamide
Transplantation
Pediatrics

Keywords

  • Acute lymphoblastic leukemia
  • Alternative donor stem cell transplantation
  • GVHD
  • Leukemia relapse

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Comparable Outcome of Alternative Donor and Matched Sibling Donor Hematopoietic Stem Cell Transplant for Children with Acute Lymphoblastic Leukemia in First or Second Remission Using Alemtuzumab in a Myeloablative Conditioning Regimen. / Kennedy-Nasser, Alana A.; Bollard, Catherine M.; Myers, G. Doug; Leung, Kathryn S.; Gottschalk, Stephen; Zhang, Yiqun; Liu, Hao; Heslop, Helen E.; Brenner, Malcolm K.; Krance, Robert A.

In: Biology of Blood and Marrow Transplantation, Vol. 14, No. 11, 01.11.2008, p. 1245-1252.

Research output: Contribution to journalArticle

Kennedy-Nasser, Alana A. ; Bollard, Catherine M. ; Myers, G. Doug ; Leung, Kathryn S. ; Gottschalk, Stephen ; Zhang, Yiqun ; Liu, Hao ; Heslop, Helen E. ; Brenner, Malcolm K. ; Krance, Robert A. / Comparable Outcome of Alternative Donor and Matched Sibling Donor Hematopoietic Stem Cell Transplant for Children with Acute Lymphoblastic Leukemia in First or Second Remission Using Alemtuzumab in a Myeloablative Conditioning Regimen. In: Biology of Blood and Marrow Transplantation. 2008 ; Vol. 14, No. 11. pp. 1245-1252.
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abstract = "HLA-matched sibling donor (MSD) stem cell transplantation can cure >60{\%} of pediatric patients with acute lymphoblastic leukemia (ALL), but <30{\%} of patients will have a sibling donor. Alternative donor (AD) transplantation can be curative but has a higher risk of graft-versus-host disease (GVHD). The addition of alemtuzumab (Campath 1-H) to AD transplants produces in vivo T cell depletion, which may reduce the risk for GVHD. We now report the outcome for 83 children with ALL (41 MSD, 42 AD) undergoing stem cell transplantation in first or second complete remission. All patients received myeloablative conditioning, including cyclophosphamide, cytarabine arabinoside, and total-body irradiation, with alemtuzumab administered to AD recipients. GVHD prophylaxis consisted of a calcineurin inhibitor with either short-course methotrexate or prednisone. Disease-free survival (DFS) for MSD recipients was 72.3{\%} (95{\%} confidence interval [CI], 55.4{\%}-83.6{\%}) versus 62.4{\%} (95{\%} CI, 45.2{\%}-75.4{\%}) for AD recipients. The 100-day mortality was 7.1{\%} in the AD group and 2.4{\%} in the MSD group. Relapse rates were identical (24{\%}). Treatment-related mortality, principally viral infection, explained the difference in survival. For children undergoing stem cell transplantation (SCT) from alternative donors, alemtuzumab with a myeloablative conditioning regimen resulted in DFS comparable to MSD.",
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AU - Bollard, Catherine M.

AU - Myers, G. Doug

AU - Leung, Kathryn S.

AU - Gottschalk, Stephen

AU - Zhang, Yiqun

AU - Liu, Hao

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